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In April 2020, the Food and Drug Administration (FDA) requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. They made this recommendation because unacceptable levels of NDMA, a probable carcinogen (or cancer-causing chemical), were present in some ranitidine products. People taking prescription ranitidine should talk with their doctor about safe alternative options before stopping the drug. People taking OTC ranitidine should stop taking the drug and talk with their healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, a person should dispose of them according to the product’s instructions or by following the FDA’s guidance.
Understanding the differences between heartburn, acid reflux, and gastroesophageal reflux disease involves understanding the links between them.
According to the American College of Gastroenterology, heartburn is a common digestive complaint in the United States, affecting more than 60 million Americans each month.
Heartburn is not a condition on its own, and it has nothing to do with the heart. Instead, it is a symptom of acid reflux.
If symptoms of acid reflux occur frequently, it can indicate that a person has gastroesophageal reflux disease (GERD).
Distinguishing between heartburn, acid reflux, and GERD may be hard, because they may all feel the same in the moment. However, understanding the differences can help a person find the right treatment.
The following symptoms can help a person to tell the difference between acid reflux, heartburn, and GERD:
Symptoms of acid reflux
Acid reflux is sometimes called gastroesophageal reflux or GER. It occurs when stomach acid travels up the food pipe to the mouth.
This can happen when the muscle at the bottom of the food pipe, which acts as a gateway to the stomach, becomes weak or loose.
Heartburn is a burning sensation in the chest or abdomen, and it has nothing to do with the heart. People often feel heartburn behind the breastbone and after eating. It can get worse when sitting or lying down.
Heartburn is the most common symptom of acid reflux, though it does not appear in every case.
Acid reflux also causes the following symptoms:
- bad breath
- nausea or vomiting
- difficulty or pain when swallowing
- breathing problems
Symptoms of GERD
GERD is the term for chronic acid reflux. The symptoms are the same, but they happen more frequently with GERD.
The stomach is built to withstand acid. The food pipe is not, and when acid rises into it, a person experiences burning pain.
The muscle at the end of the food pipe is called the lower esophageal sphincter. It can weaken or relax, and potentially cause acid reflux, for several reasons.
For example, high amounts of pressure on the abdomen can cause the sphincter to grow slack. For this reason, acid reflux is common in people who are overweight, obese, or pregnant.
Other causes of acid reflux involve:
- smoking or regular exposure to secondhand smoke
- alcohol consumption
- a type of hernia called a hiatal hernia
- eating large meals
- eating late at night or just before bed
- consuming high-fat or fried foods
- acidic drinks, such as fruit juice
Various medications can also trigger acid reflux, including:
Chest pain and related symptoms are among the top reasons for visits to emergency departments in the U.S.
Acid reflux is a common cause of chest pain, and it can be easy to confuse this pain with that of a heart attack.
Because heartburn can spread to the neck, throat, and jaw, it may feel like the radiating chest pain of a heart attack.
There are a few ways to tell the difference between heartburn and a heart attack. If the pain improves after a quick antacid or a belch, or if there is a sour taste in the mouth, a person most likely has heartburn.
A person having a heart attack often experiences a feeling of squeezing or pressure and shortness of breath.
Due to the seriousness of a heart attack, The American Heart Association recommend that anyone who believes they may be having a heart attack should seek medical care as soon as possible. This includes people who are unsure whether their chest pain results from a heart.
A doctor is a good place to start for an acid reflux or GERD diagnosis.
Assessments typically begin with a few questions and a review of the person’s medical history. The doctor may suggest changes to the diet or medications because these can influence symptoms.
If the symptoms persist, especially any related to swallowing, the doctor may work with a gastroenterologist, surgeon, or another healthcare professional to confirm a diagnosis.
Tests that can help diagnose GERD include:
- Upper gastrointestinal (GI) endoscopy and biopsy. A doctor inserts a thin, tube-like camera down the food pipe to look inside the stomach and perhaps take a tissue sample.
- Upper GI series. A doctor checks X-rays to see whether something inside the body, such as a hernia, is causing the acid reflux.
- Esophageal pH and impedance monitoring. The doctor places a thin tube inside the food pipe for about 1 day to measure acid levels.
- Bravo wireless esophageal pH monitoring. The doctor monitors acid levels using a small capsule inside the food pipe and a receiver outside the body.
- Esophageal manometry. This allows the doctor to measure muscle contractions in the food pipe.
If a person does not receive treatment for GERD, it can lead to more severe complications, including:
Acid reflux and GERD are treatable with medications, lifestyle changes, or both.
Some medications for acid reflux include:
- Antacids, which neutralize stomach acid. Options include Tums, Rolaids, Pepto-Bismol, and Mylanta. Many brands can be purchased online.
- H2 blockers, which reduce acid production. Options include Pepcid, Axid, and Tagamet.
- Proton pump inhibitors, a group of longer-term prescription medications that can reduce stomach acid. Options include Nexium, Prevacid, and Prilosec.
- Prokinetics, a type of prescription drug that helps to empty the stomach more quickly. Options include Reglan and Urecholine.
People with acid reflux or GERD can manage symptoms by taking steps to avoid triggers.
- Start by avoiding some or all of the following:
- fried and fatty foods
- large meals
- tomatoes and tomato products
- spicy food
- citrus fruits and juices
Weight loss can also help to reduce symptoms, as it decreases pressure on the food pipe.
People should also try not to eat late at night or lie down soon after eating.
In serious cases of GERD, surgery may help to strengthen the muscles in the gut.
Children and pregnancy
Children, adolescents, and pregnant women often experience acid reflux.
Heartburn may occur with 17 to 45 percent of pregnancies. Fortunately, over-the-counter heartburn and acid reflux treatments tend to be safe to use during pregnancy.
About 10 percent of teenagers and pre-teens experience GERD, according to the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.
The symptoms, diagnosis, and treatments for children with GERD are similar to those for adults. Check with a pediatrician to learn more.
If acid reflux occurs on a regular basis, use an antacid, and try different brands if the first is ineffective. Also, try making lifestyle changes, such as eliminating certain foods or drinks from the diet.
If the acid reflux still recurs after making these changes, it may be time to call the doctor.
Although chest pain is often a symptom of acid reflux or GERD, do not hesitate to visit the doctor or the emergency room if it seems more serious.
Sometimes GERD symptoms warrant urgent attention.
A person experiencing any of the following should seek immediate medical care:
- regular, forceful vomiting
- persistent upper body pain
- difficulty breathing
- difficulty swallowing
The relationship between heartburn and acid reflux is that of a symptom and its cause.
Heartburn is a painful, common problem that can affect a person’s quality of life. To eliminate it, a person needs to treat the underlying cause, which is acid reflux.
Manage symptoms of acid reflux by avoiding the many potential triggers. If acid reflux goes unchecked or untreated, it may develop into GERD.